52426 research outputs found
Sort by
Impact of Outpatient Cervical Ripening Prior to Term Induction of Labor - Prospective Randomized Trial
No full textAccelerated symptom improvement in Parkinson\u27s disease via remote internet-based optimization of deep brain stimulation therapy: a randomized controlled multicenter trial.
No full textBACKGROUND: Deep brain stimulation (DBS) has emerged as an important therapeutic intervention for neurological and neuropsychiatric disorders. After initial programming, clinicians are tasked with fine-tuning DBS parameters through repeated in-person clinic visits. We aimed to evaluate whether DBS patients achieve clinical benefit more rapidly by incorporating remote internet-based adjustment (RIBA) of stimulation parameters into the continuum of care.
METHODS: We conducted a randomized controlled multicenter study (ClinicalTrails.gov NCT05269862) involving patients scheduled for de novo implantation with a DBS System to treat Parkinson\u27s Disease. Eligibility criteria included the ability to incorporate RIBA as part of routine follow-up care. Ninety-six patients were randomly assigned in a 1:1 ratio using automated allocation, blocked into groups of 4, allocation concealed, and no stratification. After surgery and initial configuration of stimulation parameters, optimization of DBS settings occurred in the clinic alone (IC) or with additional access to RIBA. The primary outcome assessed differences in the average time to achieve a one-point improvement on the Patient Global Impression of Change score between groups. Patients, caregivers, and outcome assessors were not blinded to group assignment. Most of the data collection took place in the patient\u27s home environment.
RESULTS: Access to RIBA reduces the time to symptom improvement, with patients reporting 15.1 days faster clinical benefit (after 39.1 (SD 3.3) days in the RIBA group (n = 48) and after 54.2 (SD 3.7) days in the IC group (n = 48)). None of the reported adverse events are related to RIBA.
CONCLUSIONS: This study demonstrates safety and efficacy of internet-based adjustment of DBS therapy, while providing clinical benefit earlier than in-clinic optimization of stimulation parameters by increasing patient access to therapy adjustment
Dipeptidyl peptidase-4 inhibitor linagliptin improves fibrosis, apoptosis, and cardiac function in a large animal model of chronic myocardial ischemia
No full textMicroelectrode Recording During Deep Brain Stimulation Does Not Consistently Represent Lead Trajectory.
No full textBACKGROUND AND OBJECTIVES: Long-term outcomes in deep brain stimulation (DBS) depend on accuracy of lead placement. Microelectrode recording (MER) is a long-used adjunct to leverage neurophysiological information to confirm satisfactory trajectory of implanted electrodes. The goal of this study was to evaluate the consistency in which electrodes are placed in sampled microelectrode trajectories.
METHODS: This is a retrospective study using intraoperative computed tomography to measure final electrode deviation from MER probe placement during the DBS insertion targeting subthalamic nucleus. Fifteen patients had 29 DBS leads placed using MER assistance. Radial distance between the probe and the lead were measured for each patient using intraoperative imaging. In addition, the preoperative target to final lead error was measured in 14 patients undergoing subthalamic nucleus implants without the use of MER and compared with the 15 patients in which MER was used as an adjunct.
RESULTS: There was no significant difference in the mean radial target error (1.2 vs 1.0 mm, P = .156) when comparing the leads placed with or without MER assistance, respectively. The mean difference in final position of microelectrode compared with DBS lead was 0.9 ± 0.1 (range 0.4-2.0 mm). Of all MER-assisted electrodes placed, 44.8% (13) of electrode final positions radially deviated 1.0 mm or more from the MER probe.
CONCLUSION: Electrode placement may deviate significantly from MER trajectories. Given the concern that physiological data may not be representative of the final electrode trajectory, surgeons should consider using intraoperative imaging or other adjunctive techniques during DBS to confirm accuracy and satisfactory trajectory of DBS leads
Fetal malformations of cortical development: review and clinical guidance.
No full textMalformations of cortical development (MCDs) are a heterogeneous family of congenital brain malformations that originate from disturbed development of the cerebral cortex. MCDs can arise from primary genetic disorders that lead to dysfunction of the molecular processes controlling neuronal proliferation, neuronal migration, cortical folding or cortical organization. MCDs can also result from secondary, disruptive causes, such as congenital infection or other in utero brain injuries. Sequelae of MCDs can include epilepsy, intellectual disability and cerebral palsy, among other symptoms, with a high burden of paediatric morbidity. Advances in antenatal genetic testing and imaging have improved the ability to diagnose MCDs, yet limited literature exists to aid clinicians in prognostication of outcomes and perinatal management. These clinical realities can make it challenging for clinicians caring for fetal neurological conditions to counsel families and make recommendations for interdisciplinary care. We aim to review the literature on fetal MCDs and present practice guidelines for clinicians regarding the pre- and postnatal management of MCDs
Difficult Conversations in Fetal-Neonatal Neurology: National Survey of Educational Experiences and Needs of Child Neurology Residents.
No full textBACKGROUND: Fetal-neonatal neurology (FNN) is a growing subspecialty within child neurology that often involves difficult conversations with families regarding new neurological diagnoses and prognoses. We assessed child neurology residents\u27 educational experiences and needs regarding difficult conversations in FNN.
METHODS: We performed a descriptive survey-based study of the educational experiences of child neurology residents in their neurology training. An anonymous RedCap survey was distributed by e-mail to program directors of all US child neurology programs for distribution to residents for optional, voluntary completion.
RESULTS: Forty-seven child neurology residents in training programs in 12 states participated. Nearly all (92%) spent at least one week during the academic year providing consultations in the neonatal intensive care unit. About half participated in at least one fetal neurology consultation over the course of six months. A majority of respondents (87%) had been part of a difficult conversation in FNN, defined as delivering serious news or discussing neurological prognosis, and 68% led at least one difficult conversation over the course of six months. Respondents were more often comfortable delivering diagnoses and prognoses in neonatal neurology than in fetal neurology. A minority (32%) had communication training specific to FNN, and almost all (96%) were interested in improving their ability to conduct difficult conversations in FNN.
CONCLUSIONS: Child neurology residents were variably exposed to FNN and often actively participated in difficult conversations with families. Most residents had not had communication training specific to FNN and were interested in improving their ability to conduct difficult conversations in FNN